Provider Demographics
NPI:1972517043
Name:NELSON, I. WILLIAM (MD,PC)
Entity Type:Individual
Prefix:DR
First Name:I.
Middle Name:WILLIAM
Last Name:NELSON
Suffix:
Gender:M
Credentials:MD,PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:556 E 4020 N
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-5149
Mailing Address - Country:US
Mailing Address - Phone:801-225-5881
Mailing Address - Fax:801-434-7067
Practice Address - Street 1:556 E 4020 N
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-5149
Practice Address - Country:US
Practice Address - Phone:801-225-5881
Practice Address - Fax:801-434-7067
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1526791205207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1526791205OtherUTAH STATE LICENSE